A J&J Apple Drink is Being Confused for a WHO-Recommended ORS Solution

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Johnson & Johnson should be careful while branding its product as ‘ORSL’, a title resembling that of the ORS solution prescribed to treat dehydration from diarrhoea.

The ORSL drink has a higher osmolarity than the WHO-prescribed ORS solution, and isn’t suitable for treating dehydration due to diarrhoea. Credit: raheelshahid/Flickr, CC BY 2.0

A cleverly named and packaged drink is being sold in pharmacies – and consumers are mistakenly buying it as a treatment for diarrhoea. Consuming it is adding to the ailment, rather than bringing any relief to the patients.

ORSL is an apple drink sold in a Tetra Pak, is available in many pharmacies and is being sold as an electrolyte-enriched rehydration solution. The name of the product closely resembles the World Health Organisation (WHO)-recommended oral rehydration salts (ORS) solution. However, ORSL has neither been formulated according to the WHO-recommended proportions nor is it meant for the treatment of diarrhoea. And some pharmacies are falsely claiming it to be a “WHO-based formula” and that “it restores body fluids and electrolytes lost due to dehydration during diarrhoea”. Confused buyers go for it for the treatment of diarrhoea, in many cases without the knowledge of a doctor.

WHO defines diarrhoea as a condition in which the patient passes “three or more loose or liquid stools per day, or more frequently than is normal for the individual”. Severe diarrhoea can be life-threatening for children and people with weak immunity. WHO recommends using the glucose-electrolyte-based ORS solution for the treatment of dehydration caused by diarrhoea. It also states that “A clear distinction should be made between products recommended for treating/preventing dehydration caused by diarrhoea and preparations with compositions that are designed for replacing water and salt losses during exercise (sport drinks)”, and that some fluids are “potentially dangerous and should be avoided during diarrhoea”, especially sweetened drinks and juices, “which can cause osmotic diarrhoea and hypernatraemia”.

Dr Ashwani Koul, a pediatrician based in Bengaluru, finds it disturbing that many doctors who are prescribing ORS to their patients are unaware that they are consuming the ORSL drink instead. The total osmolarity – a measure of how concentrated a solution is – of ORSL is 585 mmol/L as against the WHO recommended ORS, which should have an osmolarity of 245 mmol/L. The higher concentration is harmful to diarrhoea patients. Dr Koul has petitioned the Food Safety and Standards Authority of India (FSSAI) to ban these Tetra Paks.

“The ORS is a WHO formulated solution for treating diarrhoea. It is supposed to be hypotonic in nature and has a set ratio of electrolytes. My concern is that the ORSL Tetra Paks are not oral rehydration solutions but just like any other fruit juice,” Dr Koul told The Wire. “The unsuspecting patients who are prescribed to take ORS by doctors are often misguided by the name and take ORSL to treat diarrhoea. This prolongs their illness and adds to the cost of investigation and treatment while the crucial fact is missed even by the doctors. I’ve had many patients coming to me with persistent diarrhoea and the only intervention needed was to stop their ORSL intake.”

Dr Newton Luiz, a consultant paediatrician at the Dhanya Mission Hospital, Thrissur, has written about a three-year-old who was admitted with profuse and watery diarrhoea. A paediatrician at a different hospital had not only suggested ORS but also surprisingly prescribed five packs of ORSL (manufactured by Jagdale Industries Limited, Bengaluru), totally amounting to a litre. Dr Luiz also found that simple apple juice could be openly mislabelled and sold as ORSL in India.

Johnson & Johnson acquired ORSL from Jagdale Industries in November 2014. In a reply to a question about the name, a spokesperson from Johnson & Johnson wrote in an email, “ORSL is recommended by healthcare practitioners as an adjuvant on the path to recovery post various illnesses like fever, heat exhaustion, heat stroke, post-surgery, flu, common cold, weakness, headache, mild sickness. We would like to reassure you that J&J does not and has never promoted ORSL for indication of diarrhoea. In fact, all promotional material for ORSL also carry disclaimers on the subject for easy understanding of our Health Care Professionals, Trade, and Consumers.”

However, experience tells us otherwise. Pharmacies continue to sell it as a remedy for dehydration caused by diarrhoea and consumers fall prey to the brand name. Diarrhoea is one of the major causes of childhood mortality in India. It is the responsibility of the manufacturers to tread carefully and brand products appropriately so they do not cause any harm to consumers.

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